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Effect of Medicare’s Nonpayment Policy on Surgical Site Infections Following Orthopedic Procedures

  • Jereen Z. Kwong (a1), Yingjie Weng (a2), Micaela Finnegan (a1), Robyn Schaffer (a1), Austin Remington (a1), Catherine Curtin (a2), Kathryn M. McDonald (a3), Jay Bhattacharya (a3) and Tina Hernandez-Boussard (a2) (a4)...



Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious hospital-acquired conditions, including SSI following certain orthopedic procedures. We aimed to evaluate the CMS policy’s effect on rates of targeted orthopedic SSIs among the Medicare population.


We examined SSI rates following orthopedic procedures among the Medicare population before and after policy implementation compared to a similarly aged control group. Using the Nationwide Inpatient Sample database for 2000–2013, we estimated rate ratios (RRs) of orthopedic SSIs among Medicare and non-Medicare patients using a difference-in-differences approach.


Following policy implementation, SSIs significantly decreased among both the Medicare and non-Medicare populations (RR, 0.7; 95% confidence interval [CI], 0.6–0.8) and RR, 0.8l; 95% CI, 0.7–0.9), respectively. However, the estimated decrease among the Medicare population was not significantly greater than the decrease among the control population (RR, 0.9; 95% CI, 0.8–1.1).


While SSI rates decreased significantly following the implementation of the CMS nonpayment policy, this trend was not associated with policy intervention but rather larger secular trends that likely contributed to decreasing SSI rates over time.

Infect Control Hosp Epidemiol 2017;38:817–822


Corresponding author

Address correspondence to Tina Hernandez-Boussard, Department of Medicine (Biomedical Informatics), Stanford School of Medicine, 1265 Welch Road, Stanford, CA 94305-5479 (


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PREVIOUS PRESENTATION. This work was presented at the 2016 Academy Health Annual Research Meeting, Boston, Massachusetts, on June 25, 2016.



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Effect of Medicare’s Nonpayment Policy on Surgical Site Infections Following Orthopedic Procedures

  • Jereen Z. Kwong (a1), Yingjie Weng (a2), Micaela Finnegan (a1), Robyn Schaffer (a1), Austin Remington (a1), Catherine Curtin (a2), Kathryn M. McDonald (a3), Jay Bhattacharya (a3) and Tina Hernandez-Boussard (a2) (a4)...


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